Criticisms of medical egalitarianism Notes for September 9

Main points

We talked about objections to medical egalitarianism from Nozick and Menzel.


There wasn’t much enthusiasm for Nozick’s brand of libertarianism. Nonetheless, I think he’s worth reading because he forces us to explain things we take for granted.

Why, for instance, is it obvious that societies are the relevant units for ethical analysis? Why aren’t there just individuals who, together, make up societies? Alternatively, why aren’t we more concerned about the health of people outside our societies? Why should a society be concerned with the health care its members receive rather than being concerned with the health care that people in general receive, regardless of where they live?

In any event, I think that he and Williams are talking past one another. Williams is talking about what it makes sense for a society and its members to do. Nozick is talking about rights and justice. Here’s a mini demonstration that they’re different. I have the right to waste my time and money. But it’s still foolish to do so.


We got straight to some fairly fundamental issues here. Jennifer and Jon both wanted to stick with some kind of medical egalitarianism. Jennifer found the endorsement of differential spending grating. Jon, following up on something Brian said, thought that Rawls’s theory, which supposes there is a single point of view that can represent everyone in a society, was more promising. That would set medical spending higher than Menzel’s approach would, but Jon was fine with that.

Adam, on the other hand, was suspicious of the idea of a representative poor person’s preferences. So it didn’t take much to lead Adam to conclude that Rawls’s theory, which supposes there is a single representative point of view on society, is even worse.

Finally, something Jennifer said struck me as a potentially interesting research topic. She noted that the poor don’t really face trade-offs between health programs and other programs. It’s not as though savings on health would be spent on something else that would benefit them. So, she concluded, the whole attack on medical egalitarianism was misleading: it supposed that there really are opportunities lost to the poor as a result of medical spending on their behalf.

The research question is: is that really so? Is there an implicit budget for the poor or are there just discrete programs, none of which trade-off against the others? In theory, there would be a rough budget and trade-offs. But political reality has a way of defeating theory.

Who is this Rawls character anyway?

We’re going to return often to John Rawls’s famous claim that a just society is one governed by principles that would be chosen in what he called the “Original Position.” So I thought I should say a word about what it is and then point you to a lot of words by someone sympathetic to the idea.

The Original Position, very briefly, is an imaginary situation in which people are supposed to chose very abstract rules to govern their society without knowing very much about themselves or the society in which they live. The idea is that a decision made in ignorance would be fair. For example, the parties in the original position would not allow for gender bias since they don’t know their own. No one wants to be on the short end of the stick, after all.

One noteworthy feature of Rawls’s Original Position is that he thinks fair decisions require eliminating all information that could be used to distinguish one person’s interests from another’s. There might as well be a single person in the Original Position since even if there were a million, they would all think exactly alike. This is what sets Rawls’s view at odds with Menzel’s. Menzel thinks that we should take the point of view of a representative poor person in deciding how social benefits for the poor should be allocated. Rawls takes the point of view of any member of society.

For a more complete description of the Original Position, without reading A Theory of Justice, of course, try the first four sections of Samuel Freeman’s article on the subject in the Stanford Encyclopedia of Philosophy.

Seventeenth-century medicine

The man I referred to was Thomas Willis. He made important discoveries about the brain. But he had to make his living as a “pisse-prophet.” Here’s what that involved.

“People would come to him with the urine of their sick relatives. He would swirl it in a flask, diagnose the malady by its color, and then prescribe a remedy.”** Carl Zimmer, Soul Made Flesh, (Free Press, 2004), p. 86.

Still, it beats what Hippocrates did!

This page was written by Michael Green for PPE Senior Seminar, PPE 190, Fall 2009. It was posted September 9, 2009 and updated September 10, 2009.
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